Israeli pediatricians will have to relearn profession, as leading Australian expert spearheads holistic, more scientific approach.

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Pediatricians have been so busy in hospitals and clinics that they haven’t
noticed the essence of their work has largely shifted from treating children for
infections, congenital diseases, injuries and other conventional care to
subjects they never learned in medical school.

There is a “new morbidity”
– a fresh collection of conditions that can make children miserable and perform
at less than their natural potential, says Australian Prof.

Frank
Oberklaid, director of the Center for Community Child Health at the Royal
Children’s Hospital and a professor of pediatrics at the University of
Melbourne. Oberklaid is also deputy chairman of the Victorian Children’s
Council, which advises the government on policy involving children’s health. He
has received numerous research grants and awards, been invited to give lectures
and granted visiting professorships in a number of countries.

A highly
developed commonwealth with the world’s 13th-largest economy and fifth-highest
per-capita income, his country is ahead of Israel in this new emphasis on
children’s behavioral, developmental and psychosocial disorders, says Oberklaid.
A Kazakhstan-born Jew and staunch supporter of Israel, Oberklaid was taken by
his parents at the age of three to Australia after World War II. The Polish
couple had lost almost all their relatives in the Holocaust and, arriving on an
ramshackle freighter from Europe with only their clothes on their backs, they
set off on a new life.

“My father worked in a knitting factory, and my
mother helped him,” says one of his country’s leading pediatricians in an
interview during a visit to Israel with The Jerusalem Post. “My brother and I
both studied medicine. I wasn’t sure what I wanted to do, but I liked the
atmosphere in a children’s hospital, with the caring staff and the kids’ toys. I
always liked children.”

He completed a specialty in pediatrics and
received a fellowship at Harvard Medical School, even serving on the staff while
he trained in child development and behavior. Then, returning to Australia, he
established a new department of ambulatory pediatrics at Royal Children’s
Hospital and is now director of the center, which has 200 staffers.

“In
the last 40 years, so many children’s disorders have been solved with
immunization and improved medications and techniques. But children’s problems
involving sleep, obesity, parental stress, endlessly crying babies, speech
delays, Asperger’s syndrome and many others have created the new diseases,” the
Australian says.

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“These problems don’t suddenly crawl out of the
woodwork. If the baby cries incessantly, is aggressive, has a lag in
toilet training and speech, there may be a problem that has to be
fixed.”

The brain is not mature at birth. Different areas of the brain
develop, organize and become fully functional at different stages during
childhood, he explains. “While genes provide the initial map for brain
development, it is an infant’s early experiences and relationships that
literally sculpt the brain. Little can be done to change a child’s genes, but
there is much we can do to change the environment in which young children grow
and develop. The evidence is startling. One can’t continue business as usual if
you are exposed to child development research based on biology, epigenetics,
economics and neuroscience. Dispassionate data has been
accumulated.”

“This holistic approach relates to the interface between
pediatrics and psychology,” he says. “Many pediatricians may not like these
changes in their field, because it is much more complicated than treating an ear
infection, for example. The pediatrics of the future aims at prevention of
multi-factorial conditions. We have to immunize children against future
failure.”

At his Melbourne hospital, which has served as a model around
the world, Oberklaid and his team offer special intervention programs, work in
translational research that reaches the young patients quickly and provide
parents and decision makers with information (at
www.raisingchildren.net).

Children are particularly vulnerable
developmentally in the earliest years of their life, he continues. Having low
socio-economic status has a major effect on early childhood development. Poverty
used to be regarded as having less money for material possessions, but today, it
is regarded as a complex, multifactorial experience that extends beyond
insufficient income.

“It incorporates the wider effects of social
exclusion, shame and reduced self-esteem and self-respect that result from a
lack of access to material and cultural resources,” he explains. “The personal
and social consequences of poverty are then more likely to affect a child’s
future prospects and quality of life.”

Children are hurt by prolonged
stress. If the parents suffer severe stress themselves, it can lead to substance
abuse, alcoholism and family violence, and the kids are hurt, he
says.

Mothers don’t have to avoid outside employment and stay home with
their young children to raise their chances for healthy
development.

Quality really matters.

“If Israel institutes free
education from age three, it will [be making] a mistake if the nursery and
kindergarten teachers and caretakers are not trained properly. You pay a huge
price if children do not get quality educations.”

Aware of the Finance
Ministry’s decision about seven years ago to privatize the Health Ministry’s
School Health Service as a “cost saving” measure – which has been deplored by
everyone from the State Comptroller to parents’ organizations – Oberklaid is
furious.

“I would love to to get my hands on the Treasury officials who
made this terrible decision. It surely has caused long-term damage. In a
growing number of countries, including Australia, officials have accepted the
philosophy of valuing early child care, development and education. More and more
education ministries around the world have expanded their names to Ministry of
Education and Child Development.”

Every two minutes a baby is born in
Australia. The structure of government in Australia is “as good as it
gets. The decision makers really understand investing in the child,” he
says.

Israel needs to mobilize all the resources it can for this target,
recommended Oberklaid.

“The Treasury has to understand it is either pay
now or pay later, and later it will be much more expensive. Any minister who
understands science will – in a second – decide against privatization of such
vital services. If cabinet ministers really care about children, they would base
their policies on scientific research. Policy must be informed by research and
not by politics.”

“In Israel, the eventual risk of ignoring these facts
is the disintegration of social infrastructure. For every Nobel Prize Israeli
scientists receive, there are huge numbers of children here who are not reaching
their potential,” declares Oberklaid, who speaks some Hebrew and visits the
country frequently. “If your finance ministry doesn’t understand this, it is
pure ignorance.”

Poverty, for example, can corrode family relationships –
parents with children, parents between themselves – creating a great deal of
harmful stress. Poverty also directly affects children’s health by increasing
the prevalence of low birthweight, infections, cerebral palsy and even obesity
later on. Parents living in poverty have higher rates of smoking, including
during pregnancy, and their children are more at risk for asthma due to passive
smoking, he says.

Mothers, points out Oberklain, are less likely to
breastfeed, which can lead to health complications. Even if they are caring and
well meaning, the poor are more likely to have poor parenting skills and suffer
from chronic stress – which is toxic – and youngsters are at higher risk for
child abuse and neglect.

The Australian physician stresses that brain
development research in the past decade has clearly shown that during a child’s
first two or three years of life, he or she is “exquisitely sensitive to the
environment, nutrition, infection and the quality of parenthood. This period
sets the foundations for the rest of their lives.”

It isn’t inevitable
that lives will be troublesome if children are improperly raised during these
early years; they can usually be repaired – but it is much more difficult and
takes much time, he says.

“Brain research shows that biologically, it is
better to get it right the first time rather than fix it. Today, we know exactly
what young children need to thrive and prosper,” stresses Oberklaid, who has
written over 150 scientific journal articles on these subjects and some books
including Health in Early Childhood Settings: From Emergencies To the Common
Cold.

The pediatrician from Australia, where there are 120,000 Jews –
70,000 in Melbourne – is not just giving free Israel advice; he is also actively
involved in making changes here.

On a February night a few years ago,
Oberklaid went to dinner in a kosher Tel Aviv restaurant called Goshen to
brainstorm with colleagues from Israel and abroad. One was Ron Finkel, president
of the Hadassah Australia Project, which raised money for a program that would
revolutionize Israeli pediatrics.

Finkel discussed how to bring to
fruition Oberklaid’s vision of a comprehensive community pediatrics
program.

Influential Israelis also present were Prof. Mati Berkovitch,
head of the Israel Pediatrics Association, and Prof. Basil (Boaz) Porter,
international coordinator of the Israel Ambulatory Pediatrics
Association.

The first step was selecting a young Hadassah pediatrician
for a two-year training fellowship, who would work with Oberklaid in
Australia.

Dr. Hava Gedassi, a physician and modern Orthodox mother of
four and married to an engineer, was chosen, and she is now completing her
training. Upon her return this summer, she will set up an academic and community
child health unit at Hadassah in Ein Kerem to implement what she
learned.

The program was called the Goshen project, named for the
restaurant, with the connotation of the ancient Israelites leaving the part of
Nile basin where they were in Egyptian bondage and going to freedom.

The
Goshen Project, Oberklaid says, will raise pediaticians’ awareness about the
importance of the early years of childhood in affecting health throughout one’s
life and of heading off poor literacy, obesity, criminality, substance abuse,
welfare dependency, mental health problems and others.

“Pediatricians and
other health professionals have an unparalleled opportunity to participate in
programs of prevention and intervention early in the life course, before
problems become entrenched,” he says.

As Prof. Porter comments, “We all
felt sure that this time things were starting to come together for child
health.”

“The Health Ministry is weak, and I’d like to see more Israeli
pediatricians step up to the plate and show leadership,” says Oberklaid. “But
the resources are here, if the medical system were properly organized. A
national steering committee will be set up to spread the Goshen Project
nationally. Other hospitals and the medical faculties are very interested, and
the health funds are also very interested in joining.”

Prof. Eitan Kerem,
head of Hadassah’s pediatric branch, and his predecessor Prof. David Bransky,
have also been very supportive.

“In my country, we have anonymous data on
health and vulnerability on 98 percent of the children. It’s all public domain,”
he concludes. For him and his Australian colleagues, “Israel is like a
laboratory for us. Our methods have to be adapted and translated, but the
principles – of one-stop, integrated services for young children – are
universal.”

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